title: Toll-like receptor 4 polymorphisms and aspergillosis in stem-cell transplantation.
abstract: BACKGROUND
  Toll-like receptors (TLRs) are essential components of the immune response to fungal pathogens. We examined the role of TLR polymorphisms in conferring a risk of invasive aspergillosis among recipients of allogeneic hematopoietic-cell transplants.
  
  
  METHODS
  We analyzed 20 single-nucleotide polymorphisms (SNPs) in the toll-like receptor 2 gene (TLR2), the toll-like receptor 3 gene (TLR3), the toll-like receptor 4 gene (TLR4), and the toll-like receptor 9 gene (TLR9) in a cohort of 336 recipients of hematopoietic-cell transplants and their unrelated donors. The risk of invasive aspergillosis was assessed with the use of multivariate Cox regression analysis. The analysis was replicated in a validation study involving 103 case patients and 263 matched controls who received hematopoietic-cell transplants from related and unrelated donors.
  
  
  RESULTS
  In the discovery study, two donor TLR4 haplotypes (S3 and S4) increased the risk of invasive aspergillosis (adjusted hazard ratio for S3, 2.20; 95% confidence interval [CI], 1.14 to 4.25; P=0.02; adjusted hazard ratio for S4, 6.16; 95% CI, 1.97 to 19.26; P=0.002). The haplotype S4 was present in carriers of two SNPs in strong linkage disequilibrium (1063 A/G [D299G] and 1363 C/T [T399I]) that influence TLR4 function. In the validation study, donor haplotype S4 also increased the risk of invasive aspergillosis (adjusted odds ratio, 2.49; 95% CI, 1.15 to 5.41; P=0.02); the association was present in unrelated recipients of hematopoietic-cell transplants (odds ratio, 5.00; 95% CI, 1.04 to 24.01; P=0.04) but not in related recipients (odds ratio, 2.29; 95% CI, 0.93 to 5.68; P=0.07). In the discovery study, seropositivity for cytomegalovirus (CMV) in donors or recipients, donor positivity for S4, or both, as compared with negative results for CMV and S4, were associated with an increase in the 3-year probability of invasive aspergillosis (12% vs. 1%, P=0.02) and death that was not related to relapse (35% vs. 22%, P=0.02).
  
  
  CONCLUSIONS
  This study suggests an association between the donor TLR4 haplotype S4 and the risk of invasive aspergillosis among recipients of hematopoietic-cell transplants from unrelated donors.
authors.affiliation: Institute for Systems Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Bochud
authors.forename: Jason W
authors.initials: JW
authors.lastname: Chien
authors.forename: Kieren A
authors.initials: KA
authors.lastname: Marr
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Leisenring
authors.forename: Arlo
authors.initials: A
authors.lastname: Upton
authors.forename: Marta
authors.initials: M
authors.lastname: Janer
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Rodrigues
authors.forename: Sarah
authors.initials: S
authors.lastname: Li
authors.forename: John A
authors.initials: JA
authors.lastname: Hansen
authors.forename: Lue Ping
authors.initials: LP
authors.lastname: Zhao
authors.forename: Alan
authors.initials: A
authors.lastname: Aderem
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001228:Aspergillosis / Q000235:genetics*; D001232:Aspergillus fumigatus; D016022:Case-Control Studies; D005260:Female; D020022:Genetic Predisposition to Disease; D006239:Haplotypes; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D015994:Incidence; D015810:Linkage Disequilibrium; D008297:Male; D008875:Middle Aged; D020641:Polymorphism, Single Nucleotide; D016016:Proportional Hazards Models; D018570:Risk Assessment; D051197:Toll-Like Receptor 4 / Q000235:genetics*; D051193:Toll-Like Receptors / Q000235:genetics; D014184:Transplantation, Homologous
chemical_list: C495345:TLR4 protein, human; D051197:Toll-Like Receptor 4; D051193:Toll-Like Receptors